Effects of calcium chloride coadministered with neostigmine on neuromuscular blockade recovery: A double-blind randomised study.

BACKGROUND: Ionised calcium plays an important role in neuromuscular transmission, but its effects on the reversal of nondepolarising neuromuscular blockade have not been fully evaluated. OBJECTIVE: We examined whether calcium chloride coadministered with neostigmine could enhance the rate of neuromuscular recovery. DESIGN: Prospective randomised double-blind trial. SETTING: A tertiary teaching hospital. PATIENTS: In total, 53 patients undergoing elective surgery under general anaesthesia with neuromuscular monitoring by acceleromyography using a TOF-Watch SX monitor. INTERVENTIONS: Patients were randomly allocated to receive either 5 mg kg-1 of calcium chloride (calcium group, n = 26) or the same volume of normal saline (control group, n = 27) coadministered with 25 [mu]g kg-1 of neostigmine and 15 [mu]g kg-1 of atropine at the end of surgery. MAIN OUTCOME MEASURES: The primary end point was the neuromuscular recovery time [time from neostigmine administration to recovery of the TOF ratio (TOFr) to 0.9]. Secondary end points included the TOFr at 5, 10 and 20 min after neostigmine administration and the incidence of postoperative residual curarisation (PORC), defined as a TOFr less than 0.9 at each time point. RESULTS: The neuromuscular recovery time was significantly faster in the calcium group than in the control group (median [Q1 to Q3]; 5.0 [3.0 to 7.0] vs. 6.7 [5.7 to 10.0] min, respectively; P = 0.007). At 5 min after neostigmine administration, the TOFr was higher [87 (74 to 100) vs. 68 (51 to 81)%, respectively; P = 0.002] and the incidence of PORC was lower (50.0 vs. 81.5%, respectively; P = 0.016) in the calcium group than in the control group. There were no differences between the two groups with respect to the TOFr or incidence of PORC at 10 and 20 min after neostigmine administration. CONCLUSION: Calcium chloride coadministered with neostigmine enhanced neuromuscular recovery in the early period of nondepolarising neuromuscular blockade reversal. (C) 2017 European Society of Anaesthesiology

http://ift.tt/2q3a9Og

Intraoperative magnesium sulphate decreases agitation and pain in patients undergoing functional endoscopic surgery: A randomised double-blind study.

BACKGROUND: Postoperative agitation is harmful for the patient as it may be associated with removal of catheters, nasal packs, oxygen masks and self-injury, and pose a danger to operating theatre staff. OBJECTIVE: The current study investigated the potential role of magnesium sulphate in treatment of postoperative agitation following functional endoscopic sinus surgery. DESIGN: A randomised, double-blinded, placebo-controlled trial. SETTING: ENT operating room, Menofia University Hospitals, Egypt. PATIENTS: A total of 312 adult patients (171 men and 141 women) were enrolled in the study. Eighteen patients (10 men and eight women) were excluded; data from 294 patients were analysed. Inclusion criteria were age between 20 and 60 years, American Society of Anesthesiologists' physical status 1 or 2 scheduled for functional endoscopic sinus surgery. Exclusion criteria were hypertension, cardiac ischaemia, cerebrovascular insufficiency, neuromuscular diseases, pregnancy, prolonged treatment with calcium-channel blockers, diabetic neuropathy or a known allergy to magnesium compounds. INTERVENTIONS: Patients were allocated randomly to either the magnesium group (a magnesium infusion of 30 mg kg-1 in the first hour followed by 9 mg kg-1 h-1 until the end of the surgical procedure) or the control group (0.9% saline at the same volume and rate). Hypotensive anaesthesia was induced by nitroglycerine 5 to 20 [mu]g kg-1 min-1. In the postanaesthetic care unit (PACU), patients were assessed for agitation and pain using the Richmond agitation-sedation scale and numerical rating scale, respectively. PRIMARY OUTCOME: The incidence and severity of agitation measured 5 min after admission to the PACU. RESULTS: Magnesium reduced postoperative agitation at time 0 (P = 0.009) and 5, 10, 15 and 30 min after PACU admission (P

http://ift.tt/2rnOzYF

Comparison of laryngeal mask airway insertion methods, including the external larynx lift with pre-inflated cuff, on postoperative pharyngolaryngeal complications: A randomised clinical trial.

BACKGROUND: Postoperative pharyngolaryngeal complications are commonly reported following laryngeal mask airway (LMA) insertion. After induction of anaesthesia, the airway structures fall backwards under the influence of gravity, and this may contribute to difficulty in placement of a LMA. External airway alignment by lifting the larynx during insertion of an airway may avoid collision of the airway with laryngeal structures. OBJECTIVE(S): To compare pharyngolaryngeal complications after either conventional airway insertion with or without cuff semi-inflation and a method, including an external larynx lift. DESIGN: Randomised controlled double blind clinical trial. SETTING: Ambulatory surgical operating rooms of a university hospital. PATIENTS: American Society of Anaesthesiologists class 1 to 3 patients undergoing ambulatory surgery scheduled to receive general anaesthesia for which a LMA was not contraindicated. INTERVENTIONS: Patients were randomised into three groups for LMA placement: G1, deflated airway; G2, pre-inflated cuff; G3, pre-inflated cuff with external lifting of the larynx. Assessment of pharyngolaryngeal complications (blinded assessor) was made at the time of LMA removal and again at 1, 2 and 24 h. MAIN OUTCOME MEASURES: A pharyngolaryngeal complication, defined as a composite of one or more of sore throat, dysphonia or dysphagia at any time point, or blood on the airway at removal. RESULTS: Of the 450 consecutive patients, 441 were studied. There were no differences in insertion times or number of insertion attempts among the groups. There was no difference in pharyngolaryngeal complications among the groups: G1, 57%; G2, 55%; G3, 52%, (P = 0.77). Blood on the airway was observed less frequently in G3 (9%) compared with G1 and G2 combined (17%): difference -8% (95% confidence interval of the difference -0.8 to -16%, P = 0.01). CONCLUSION: The external larynx lift technique was associated with a lower incidence of blood on the airway at removal, suggesting that the method may decrease trauma to the tissues of the upper airway during insertion. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01749033. (C) 2017 European Society of Anaesthesiology

http://ift.tt/2q2IhKe

Perioperative factors related to the severity of vocal cord paralysis after thoracic cardiovascular surgery: A retrospective review.

BACKGROUND: Vocal cord paralysis (VCP) is a rare complication of thoracic cardiovascular surgery. In severe cases, life-threatening airway obstruction may occur. OBJECTIVE: To evaluate the incidence and severity of VCP among patients who underwent thoracic cardiovascular surgery and to identify possible risk factors. DESIGN: Single-centre retrospective review of adult patients. SETTING: Osaka University Hospital, Suita, Japan, from January 2013 to August 2015. PATIENTS: We included 688 patients in the final analysis. Preoperative, intraoperative and postoperative data were collected from medical records. Patients with preoperative VCP or tracheostomy prior to extubation were excluded. The VCP severity in relation to functional recovery was graded using the following categories: absent; mild, remission at 6 months; moderate, partial or persistent VCP at 6 months; or severe, airway obstruction after extubation requiring reintubation. An otolaryngologist diagnosed all VCP cases. MAIN OUTCOME MEASURES: The incidence and severity of VCP after extubation. RESULTS: The incidence (number) of VCP was 4.7% (32), with those of mild, moderate and severe VCP being 1.7% (12), 1.5% (10) and 1.5% (10), respectively. The ICU stay was significantly longer in patients with severe VCP than in patients without VCP [12.5 days (interquartile range 5.5 to 25.5) vs. 3 days (interquartile range 2 to 5), P = 0.0002]. In our multivariable analysis, type 2 diabetes mellitus [odds ratio (OR) 1.853, P = 0.009], intubation period (OR per 24 h 1.136, P = 0.014), ascending aortic arch surgery with brachiocephalic artery reconstruction (OR 8.708, P

http://ift.tt/2rnKWSG

Effects of dexamethasone on early cognitive decline after cardiac surgery: A randomised controlled trial.

BACKGROUND: Postoperative cognitive decline (POCD), a very common complication after cardiac surgery, is characterised by impairment of both memory function and intellectual ability as well as being associated with increased use of healthcare resources. The investigators focused on the role of the inflammatory response to a surgical procedure as a potential factor involved in the pathogenesis of POCD. OBJECTIVE: The use of prophylactic dexamethasone to attenuate the inflammatory response was hypothesised to reduce the risk of POCD. DESIGN: Randomised controlled study. SETTING: Single university teaching hospital, from March 2015 to January 2016. PATIENTS: A total of 169 patients scheduled for elective cardiac surgery were enrolled, and 161 patients were included in the analyses. INTERVENTION: Patients were randomised to receive a single intravenous bolus of 0.1 mg kg-1 dexamethasone (n = 85) or placebo (n = 84) 10 h before the surgery. MAIN OUTCOME MEASURES: The primary outcome measure in both groups was the incidence of POCD on the 6th day after surgery. The investigators also evaluated the effect of dexamethasone on the incidence of systemic inflammatory response syndrome, postoperative C-reactive protein levels and postoperative serum S100[beta] protein levels. RESULTS: Compared to the placebo group, the dexamethasone group showed statistically significant reductions in the incidence of POCD (relative risk, 0.43; 95% confidence interval, 0.21 to 0.89; P = 0.02), the incidence of systemic inflammatory response syndrome (30.0 versus 58.0%, P

http://ift.tt/2q2DNmQ

Anaesthesiology research in the European Union and the European Free Trade Association: An overview from 2001 to 2015.

BACKGROUND: Publication performance in anaesthesiology hints at research activity and attractiveness for a particular centre or country for anaesthetists. OBJECTIVE: The aim of this retrospective bibliographic study is to compare the publication performance of anaesthesiology departments within the countries of the European Union (EU) and European Free Trade Association (EFTA) combined. Outcome measures were the number of publications, the number of original articles, the average impact factor and the number of publications and average impact factor per million inhabitants. METHODS: Articles from anaesthesiology departments within the EU and EFTA countries published between 1 January 2001 and 31 December 2015 were included. Articles were electronically imported from Medline into a database and linked to anaesthesiology departments according to the authors' affiliations. Publication performance was assessed for 2001 to 2005, 2006 to 2010, 2011 to 2015 and 2001 to 2015. RESULTS: From 2001 to 2015, the absolute number of articles increased from 10 513 to 19 037 (+81%), whereas the number of original research articles decreased from 3786 to 1563 (-58%). Germany had the most publications (8948) with 1967 of these being original articles. Denmark achieved not only the highest average impact factor per million inhabitants (319.9) but also the most articles per anaesthesiologist (1.46), and per million habitants (105.7). Countries which moved up the income scale to a higher income class also increased the number of publications. DISCUSSION: In the EU and EFTA countries, the total number of publications increased from 2001 to 2015, but the number of original research articles fell by more than 50%. CONCLUSION: Between 2001 and 2015, in the EU and EFTA countries, the number of publications increased, whereas the number of original articles decreased. Germany published most, but Denmark had most publications per anaesthesiologist and per capita, and also achieved the highest impact factor per article. (C) 2017 European Society of Anaesthesiology

http://ift.tt/2rnNjEO

Zika Virus: Obstetric and Pediatric Anesthesia Considerations

As of November 2016, the Florida Department of Health (FDH) and the Centers for Disease Control and Prevention have confirmed more than 4000 travel-related Zika virus (ZIKV) infections in the United States with >700 of those in Florida. There have been 139 cases of locally acquired infection, all occurring in Miami, Florida. Within the US territories (eg, Puerto Rico, US Virgin Islands), >30,000 cases of ZIKV infection have been reported. The projected number of individuals at risk for ZIKV infection in the Caribbean and Latin America approximates 5 million. Similar to Dengue and Chikungunya viruses, ZIKV is spread to humans by infected Aedes aegypti mosquitoes, through travel-associated local transmission, via sexual contact, and through blood transfusions. South Florida is an epicenter for ZIKV infection in the United States and the year-round warm climate along with an abundance of mosquito vectors that can harbor the flavivirus raise health care concerns. ZIKV infection is generally mild with clinical manifestations of fever, rash, conjunctivitis, and arthralgia. Of greatest concern, however, is growing evidence for the relationship between ZIKV infection of pregnant women and increased incidence of abnormal pregnancies and congenital abnormalities in the newborn, now medically termed ZIKA Congenital Syndrome. Federal health officials are observing 899 confirmed Zika-positive pregnancies and the FDH is currently monitoring 110 pregnant women with evidence of Zika infection. The University of Miami/Jackson Memorial Hospital is uniquely positioned just north of downtown Miami and within the vicinity of Liberty City, Little Haiti, and Miami Beach, which are currently "hot spots" for Zika virus exposure and transmissions. As the FDH works fervently to prevent a Zika epidemic in the region, health care providers at the University of Miami and Jackson Memorial Hospital prepare for the clinical spectrum of ZIKV effects as well as the safe perioperative care of the parturients and their affected newborns. In an effort to meet anesthetic preparedness for the care of potential Zika-positive patients and perinatal management of babies born with ZIKA Congenital Syndrome, this review highlights the interim guidelines from the Centers for Disease Control and Prevention and also suggest anesthetic implications and recommendations. In addition, this article reviews guidance for the evaluation and anesthetic management of infants with congenital ZIKV infection. To better manage the perioperative care of affected newborns, this article also reviews the comparative anesthetic implications of babies born with related congenital malformations.

http://ift.tt/2rnWDsm

Coming to a Patient Near You: The Zika Virus and Anesthetic Implications

No abstract available

http://ift.tt/2rnFOh8

Subcellular Hypoxia: A Survival Guide

No abstract available

http://ift.tt/2rnHgjH

Subcellular Energetics and Metabolism: Potential Therapeutic Applications

Part I of this review discussed the similarities between embryogenesis, mammalian adaptions to hypoxia (primarily driven by hypoxia-inducible factor-1 [HIF-1]), ischemia-reperfusion injury (and its relationship with reactive oxygen species), hibernation, diving animals, cancer, and sepsis, and it focused on the common characteristics that allow cells and organisms to survive in these states. Part II of this review describes techniques by which researchers gain insight into subcellular energetics and identify potential future tools for clinicians. In particular, P31 nuclear magnetic resonance to measure high-energy phosphates, serum lactate measurements, the use of near-infrared spectroscopy to measure the oxidation state of cytochrome aa3, and the ability of the protoporphyrin IX-triplet state lifetime technique to measure mitochondrial oxygen tension are discussed. In addition, this review discusses novel treatment strategies such as hyperbaric oxygen, preconditioning, exercise training, therapeutic gases, as well as inhibitors of HIF-1, HIF prolyl hydroxylase, and peroxisome proliferator-activated receptors.

http://ift.tt/2rnvWnz

Subcellular Energetics and Metabolism: A Cross-Species Framework

Although it is generally believed that oxidative phosphorylation and adequate oxygenation are essential for life, human development occurs in a profoundly hypoxic environment and "normal" levels of oxygen during embryogenesis are even harmful. The ability of embryos not only to survive but also to thrive in such an environment is made possible by adaptations related to metabolic pathways. Similarly, cancerous cells are able not only to survive but also to grow and spread in environments that would typically be fatal for healthy adult cells. Many biological states, both normal and pathological, share underlying similarities related to metabolism, the electron transport chain, and reactive species. The purpose of Part I of this review is to review the similarities among embryogenesis, mammalian adaptions to hypoxia (primarily driven by hypoxia-inducible factor-1), ischemia-reperfusion injury (and its relationship with reactive oxygen species), hibernation, diving animals, cancer, and sepsis, with a particular focus on the common characteristics that allow cells and organisms to survive in these states.

http://ift.tt/2rnvXrD

Botulinum toxin therapy: functional silencing of salivary disorders.

Related Articles

Botulinum toxin therapy: functional silencing of salivary disorders.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):168-171

Authors: Lovato A, Restivo DA, Ottaviano G, Marioni G, Marchese-Ragona R

Abstract
Botulinum toxin (BTX) is a neurotoxic protein produced by Clostridium botulinum, an anaerobic bacterium. BTX therapy is a safe and effective treatment when used for functional silencing of the salivary glands in disorders such as sialoceles and salivary fistulae that may have a post-traumatic or post-operative origin. BTX injections can be considered in sialoceles and salivary fistulae after the failure of or together with conservative treatments (e.g. antibiotics, pressure dressings, or serial aspirations). BTX treatment has a promising role in chronic sialadenitis. BTX therapy is highly successful in the treatment of gustatory sweating (Frey's syndrome), and could be considered the gold standard treatment for this neurological disorder.

PMID: 28516981 [PubMed - in process]

http://ift.tt/2rnZFx0

Modern management of paediatric obstructive salivary disorders: long-term clinical experience.

Related Articles

Modern management of paediatric obstructive salivary disorders: long-term clinical experience.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):160-167

Authors: Capaccio P, Canzi P, Gaffuri M, Occhini A, Benazzo M, Ottaviani F, Pignataro L

Abstract
Recent technological improvements in head and neck field have changed diagnostic and therapeutic strategies for salivary disorders. Diagnosis is now based on colour Doppler ultrasonography (US), magnetic resonance (MR) sialography and cone beam 3D computed tomography (CT), and extra- and intracorporeal lithotripsy, interventional sialendscopy and sialendoscopy-assisted surgery are used as minimally invasive, conservative procedures for functional preservation of the affected gland. We evaluated the results of our long-term experience in the management of paediatric obstructive salivary disorders. The study involved a consecutive series of 66 children (38 females) whose obstructive salivary symptoms caused by juvenile recurrent parotitis (JRP) (n = 32), stones (n = 20), ranula (n = 9) and ductal stenosis (n = 5). 45 patients underwent interventional sialendoscopy for JRP, stones and stenoses, 12 a cycle of extracorporeal shockwave lithotripsy (ESWL), three sialendoscopy-assisted transoral surgery, one drainage, six marsupialisation, and two suturing of a ranula. Three children underwent combined ESWL and interventional sialendoscopy, and seven a secondary procedure. An overall successful result was obtained in 90.9% of cases. None of the patients underwent traditional invasive sialadenectomy notwithstanding persistence of mild obstructive symptoms in six patients. No major complications were observed. Using a diagnostic work-up based on colour Doppler US, MR sialography and cone beam 3D TC, children with obstructive salivary disorders can be effectively treated in a modern minimally-invasive manner by extracorporeal and intracorporeal lithotripsy, interventional sialendoscopy and sialendoscopy-assisted transoral surgery; this approach guarantees a successful result in most patients, thus avoiding the need for invasive sialadenectomy while functionally preserving the gland.

PMID: 28516980 [PubMed - in process]

http://ift.tt/2qZebv3

Interventional sialendoscopy for radioiodine-induced sialadenitis: quo vadis?

Related Articles

Interventional sialendoscopy for radioiodine-induced sialadenitis: quo vadis?

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):155-159

Authors: Canzi P, Cacciola S, Capaccio P, Pagella F, Occhini A, Pignataro L, Benazzo M

Abstract
Salivary gland toxicity is a common adverse effect of radioactive iodine ((131)I) for the treatment of thyroid cancers with a prevalence ranging from 2% to 67% of the (131)I exposed population. Recently, sialendoscopy has been introduced as an attractive diagnostic and therapeutic tool for management of patients with radioiodine-induced sialadenitis that is unresponsive to standard medical treatments. The objective of the current review was to assess the impact of this procedure on outcomes in patients suffering from radioiodine sialadenitis. Overall, eight studies were included and 122 patients underwent 264 sialendoscopic procedures. Duct stenosis and mucous plugs were observed in 85.7% of endoscopic findings, supporting the role of ductal obstruction in the pathophysiology of radioiodine sialadenitis. In total, 89.3% of patients experienced complete or partial resolution of sialadenitis recurrences without any major adverse events, and parotidectomy was advocated in only 1 case. However, outcomes mainly concerned subjective reports and only two clinical experiences evaluated objective measurement with dissimilar results. Limited to few studies, xerostomia and obstructive symptoms responded differently after sialendoscopy. The optimal timing of salivary gland videoendoscopy needs to be further analysed in order to define the best management of radioiodine-induced obstructive sialadenitis.

PMID: 28516979 [PubMed - in process]

http://ift.tt/2qAdU0T

Sialendoscopic management of autoimmune sialadenitis: a review of literature.

Related Articles

Sialendoscopic management of autoimmune sialadenitis: a review of literature.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):148-154

Authors: Gallo A, Martellucci S, Fusconi M, Pagliuca G, Greco A, De Virgilio A, De Vincentiis M

Abstract
Autoimmune diseases of major salivary glands include Sjögren's syndrome and a complex of disorders classified as immunoglobulin G4-related diseases. These pathologies are characterised by an autoimmune reaction mediated by T-helper lymphocytes that targets the ducts of exocrine glands in Sjögren's syndrome and glandular parenchyma in immunoglobulin G4-related diseases. Immunoglobulin G4-related diseases represent recently introduced multi-organ diseases that also involve the salivary glands. However, the morbid conditions once known as Mikulicz's disease and Kuttner's tumour were recently considered as two variants of immunoglobulin G4-related diseases affecting the major salivary glands ( immunoglobulin G4-related sialadenitis). This review briefly summarises the pathogenesis and clinical features of autoimmune diseases of the major salivary glands, focusing on the diagnostic and therapeutic role of sialendoscopy.

PMID: 28516978 [PubMed - in process]

http://ift.tt/2q2FLU3

Complications of traditional and modern therapeutic salivary approaches.

Related Articles

Complications of traditional and modern therapeutic salivary approaches.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):142-147

Authors: Nahlieli O

Abstract
The morbidity following traditional surgery of the salivary glands is well documented and includes postsurgical complications such as the Frey's syndrome, complete or partial facial nerve damage, facial scarring, greater auricular nerve numbness, sialocoeles and salivary fistula. The avulsion of the salivary duct, secondary strictures, gland swelling, salivary fistulas and perforations (false rout), traumatic ranulas, and the lingual nerve paraesthesia are the main endoscopy-related complications. In general, the rate of postsurgical complications after modern advanced minimally invasive surgical interventions is significantly lower compared with traditional surgery of the salivary glands. However, such comparisons cannot be performed because up-to-date traditional and minimally invasive surgical techniques are applied to different salivary disorders. Combinations of various minimally invasive techniques are also possible. There is no clear borderline between "traditional" and "modern" surgery of the salivary glands. It is appropriate to write about gradual replacement of old techniques with newer ones, and this process has no traffic lights.

PMID: 28516977 [PubMed - in process]

http://ift.tt/2q2BFeV

Salivary duct stenosis: diagnosis and treatment.

Related Articles

Salivary duct stenosis: diagnosis and treatment.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):132-141

Authors: Koch M, Iro H

Abstract
The management of stenoses of the major salivary glands had undergone a significant change during the last 15-20 years. Accurate diagnosis forms the basis of adapted minimal invasive therapy. Conventional sialography and MR-sialography are useful examination tools, and ultrasound seems to be a first-line investigational tool if salivary duct stenosis is suspected as cause of gland obstruction. Sialendoscopy is the best choice to establish final diagnosis and characterise the stenosis in order to plan accurate treatment. In all major salivary glands, inflammatory stenosis can be distinguished from fibrotic stenosis. In the parotid duct system, an additional stenosis associated with various abnormalities of the duct system has been reported. Conservative therapy is not sufficient in the majority of cases. The development of a minimally invasive treatment regime, in which sialendoscopy plays a major role, has made the preservation of the gland and its function possible in over 90% of cases. Ductal incision procedures are the most important measure in submandibular duct stenoses, but sialendoscopy becomes more important in the more centrally located stenoses. Sialendoscopic controlled opening and dilation is the dominating method in parotid duct stenoses. In 10-15% of cases, success can be achieved after a combined treatment regime had been applied. This review article aims to give an overview on the epidemiology, diagnostics and current state of the art of the treatment of salivary duct stenoses.

PMID: 28516976 [PubMed - in process]

http://ift.tt/2ryEXrm

Sialendoscopy-assisted transfacial removal of parotid calculi.

Related Articles

Sialendoscopy-assisted transfacial removal of parotid calculi.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):128-131

Authors: Hills AJ, Holden AM, McGurk M

Abstract
Superficial parotidectomy has significant morbidity, and minimally invasive techniques have therefore been developed, including those involving sialendoscopy, to remove sialoliths and preserve the gland along with its function. The size, mobility and location of the sialolith, alongside the presence of strictures, all dictate management. We outline basic treatment paradigms and describe two sialoendoscopyassisted surgical procedures developed for treating stones, one intraoral and one extraoral.

PMID: 28516975 [PubMed - in process]

http://ift.tt/2rnZEcq

Sialendoscope-assisted transoral removal of hilo-parenchymal sub-mandibular stones: surgical results and subjective scores.

Related Articles

Sialendoscope-assisted transoral removal of hilo-parenchymal sub-mandibular stones: surgical results and subjective scores.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):122-127

Authors: Capaccio P, Gaffuri M, Rossi V, Pignataro L

Abstract
It has been suggested that a conservative trans-oral approach to proximal and hilo-parenchymal submandibular stones (HPSMS) is a valid alternative to the more frequently used sialadenectomy. The aim of this study was to evaluate the surgical, ultrasonographic and patients' subjective outcomes of results of the trans-oral removal of HPSMS. Between January 2003 and September 2015, sialendoscope-assisted trans-oral surgery was used to remove symptomatic, large (> 7 mm), fixed and palpable HPSMS from 479 patients under general anaesthesia. All patients were followed clinically and ultrasonographically to investigate symptom relief and recurrence of stones, and were telephonically interviewed to assess saliva-related subjective outcomes with a questionnaire. Stones were successfully removed from 472 patients (98.5%); the seven failures (1.5%) concerned pure parenchymal stones. One year after the procedure, 408 patients (85.1%) were symptom free, 59 (12.3%) had recurrent obstructive symptoms and 12 (2.6%) had recurrent infections. Of the 54 patients who developed a recurrent stone (11.2%), 52 underwent a second procedure: 29 interventional sialendoscopies, two sialendoscope-assisted intra-corporeal pneumatic lithotripsy, eight secondary transoral surgery to remove residual stones, six a cycle of extra-corporeal lithotripsy and seven submandibular sialadenectomy. Most patients (75.2%) reported mild surgery-related pain. The symptoms of 454 patients (94.8%) improved after adjunctive treatment and, at the end of follow-up, the affected gland was preserved in 98.5% of patients. A sialendoscope-assisted trans-oral removal of large HPSMS is a safe, effective, conservative surgical procedure, and functional preservation of the main duct and parenchyma of the obstructed gland allows sialendoscopic access through the natural ostium in case of recurrence. Combining a trans-oral approach with other minimally invasive, conservative procedures ensures symptomatic relief and salivary duct system clearance in the majority of patients.

PMID: 28516974 [PubMed - in process]

http://ift.tt/2rnQdtv

Salivary lithotripsy in the era of sialendoscopy.

Related Articles

Salivary lithotripsy in the era of sialendoscopy.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):113-121

Authors: Capaccio P, Torretta S, Pignataro L, Koch M

Abstract
The traditional management of obstructive salivary disorders has been replaced by minimally-invasive gland-preserving techniques including shock-wave lithotripsy, sialendoscopy, interventional radiology and endoscopically video-assisted trans-oral and cervical stone retrieval, of which sialendoscopy is considered to be the method of first choice. Primary endoscopically controlled stone extraction without prior fragmentation is only possible in 15-20% of cases; in more than 80%, fragmentation is necessary because of the size, impactation and location of the stone, or an alternative treatment such as transoral duct surgery or combined approaches are required. Moreover, about 10-20% of all stones cannot be adequately accessed by means of a sialendoscope or any alternative surgical method and, in such cases, extra-corporeal shock wave lithotripsy (ESWL) is the treatment of choice. However, in endoscopically accessible stones, ESWL is being gradually replaced by endoscopically assisted intra-corporeal techniques, including endoscopically guided laser and pneumatic intracorporeal lithotripsy. We describe the currently most widely used techniques for salivary lithotripsy, including ESWL, and endoscopically guided laser, electrohydraulic, electrokinetic and pneumatic intra-corporeal lithotripsy, and discuss their indications given the widespread use of advanced rehabilitative sialendoscopy and combined therapeutic approaches.

PMID: 28516973 [PubMed - in process]

http://ift.tt/2rniRuM

Sialendoscopy for salivary stones: principles, technical skills and therapeutic experience.

Related Articles

Sialendoscopy for salivary stones: principles, technical skills and therapeutic experience.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):102-112

Authors: Carta F, Farneti P, Cantore S, Macrì G, Chuchueva N, Cuffaro L, Pasquini E, Puxeddu R

Abstract
Obstructive sialadenitis is the most common non-neoplastic disease of the salivary glands, and sialendoscopy is increasingly used in both diagnosis and treatment, associated in selected cases with endoscopic laser lithotripsy. Sialendoscopy is also used for combined minimally invasive external and endoscopic approaches in patients with larger and proximal stones that would require excessively long laser procedures. The present paper reports on the technical experience from the Ear, Nose and Throat Unit of the Sant'Orsola-Malpighi Hospital of Bologna, and from the Department of Otorhinolaryngology of the University Hospital of Cagliari, Italy, including the retrospective analysis of the endoscopic and endoscopic assisted procedures performed on 48 patients (26 females and 22 males; median age 45.3; range 8-83 years) treated for chronic obstructive sialadenitis at the University Hospital of Cagliari from November 2010 to April 2016. The results from the Sant'Orsola-Malpighi Hospital of Bologna have been previously published. The technical aspects of sialendoscopy are carefully described. The retrospective analysis of the University Hospital of Cagliari shows that the disease was unilateral in 40 patients and bilateral in 8; a total of 56 major salivary glands were treated (22 submandibular glands and 34 parotids). Five patients underwent bilateral sialendoscopy for juvenile recurrent parotitis. 10 patients were treated for non-lithiasic obstructive disease. In 33 patients (68.75%) the obstruction was caused by salivary stones (bilateral parotid lithiasis in 1 case). Only 8 patients needed a sialectomy (5 submandibular glands and 3 parotids). The conservative approach to obstructive sialadenitis is feasible and can be performed either purely endoscopically or in a combined modality, with a high percentage of success. The procedure must be performed with dedicated instrumentation by a skilled surgeon after proper training since minor to major complications can be encountered. Sialectomy should be the "extrema ratio" after failure of a conservative approach.

PMID: 28516972 [PubMed - in process]

http://ift.tt/2rnKWC1

Salivary biomarkers and proteomics: future diagnostic and clinical utilities.

Related Articles

Salivary biomarkers and proteomics: future diagnostic and clinical utilities.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):94-101

Authors: Castagnola M, Scarano E, Passali GC, Messana I, Cabras T, Iavarone F, Di Cintio G, Fiorita A, De Corso E, Paludetti G

Abstract
Saliva testing is a non-invasive and inexpensive test that can serve as a source of information useful for diagnosis of disease. As we enter the era of genomic technologies and -omic research, collection of saliva has increased. Recent proteomic platforms have analysed the human salivary proteome and characterised about 3000 differentially expressed proteins and peptides: in saliva, more than 90% of proteins in weight are derived from the secretion of three couples of "major" glands; all the other components are derived from minor glands, gingival crevicular fluid, mucosal exudates and oral microflora. The most common aim of proteomic analysis is to discriminate between physiological and pathological conditions. A proteomic protocol to analyze the whole saliva proteome is not currently available. It is possible distinguish two type of proteomic platforms: top-down proteomics investigates intact naturally-occurring structure of a protein under examination; bottom-up proteomics analyses peptide fragments after pre-digestion (typically with trypsin). Because of this heterogeneity, many different biomarkers may be proposed for the same pathology. The salivary proteome has been characterised in several diseases: oral squamous cell carcinoma and oral leukoplakia, chronic graft-versus-host disease Sjögren's syndrome and other autoimmune disorders such as SAPHO, schizophrenia and bipolar disorder, and genetic diseases like Down's Syndrome and Wilson disease. The results of research reported herein suggest that in the near future human saliva will be a relevant diagnostic fluid for clinical diagnosis and prognosis.

PMID: 28516971 [PubMed - in process]

http://ift.tt/2qZbr0Q

Diagnostic work-up in obstructive and inflammatory salivary gland disorders.

Related Articles

Diagnostic work-up in obstructive and inflammatory salivary gland disorders.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):83-93

Authors: Ugga L, Ravanelli M, Pallottino AA, Farina D, Maroldi R

Abstract
Inflammatory and obstructive disorders of the salivary glands are caused by very different pathological conditions affecting the gland tissue and/or the excretory system. The clinical setting is essential to address the appropriate diagnostic imaging work-up. According to history and physical examination, four main clinical scenarios can be recognised: (1) acute generalised swelling of major salivary glands; (2) acute swelling of a single major salivary gland; (3) chronic generalised swelling of major salivary glands, associated or not with "dry mouth"; (4) chronic or prolonged swelling of a single major salivary gland. The algorithm for imaging salivary glands depends on the scenario with which the patient presents to the clinician. Imaging is essential to confirm clinical diagnosis, define the extent of the disease and identify complications. Imaging techniques include ultrasound (US), computed tomography (CT) and magnetic resonance (MR) with MR sialography.

PMID: 28516970 [PubMed - in process]

http://ift.tt/2q2BD6N

Voluminous laryngeal schwannoma excision with a mini-invasive external approach: a case report.

Related Articles

Voluminous laryngeal schwannoma excision with a mini-invasive external approach: a case report.

Acta Otorhinolaryngol Ital. 2017 Jun;37(3):242-244

Authors: Tulli M, Bondi S, Bussi M

Abstract
Laryngeal schwannomas are extremely uncommon. We present a case of bulky supraglottic schwannoma with involvement of the preepiglottic and superior paraglottic spaces. Clinical findings, computed tomography and magnetic resonance images are presented. These characteristics are typical, however not specific to schwannomas. For definitive diagnosis, histology and immunohistochemistry are necessary. We present an external mini-invasive approach that allowed us to both obtain diagnosis and provide definitive treatment for this kind of voluminous laryngeal tumour.

PMID: 28516969 [PubMed - in process]

http://ift.tt/2qZrnAi

Preliminary experience with 4K ultra-high definition endoscope: analysis of pros and cons in skull base surgery.

Related Articles

Preliminary experience with 4K ultra-high definition endoscope: analysis of pros and cons in skull base surgery.

Acta Otorhinolaryngol Ital. 2017 Jun;37(3):237-241

Authors: Rigante M, La Rocca G, Lauretti L, D'Alessandris GQ, Mangiola A, Anile C, Olivi A, Paludetti G

Abstract
During the last two decades endoscopic skull base surgery observed a continuous technical and technological development 3D endoscopy and ultra High Definition (HD) endoscopy have provided great advances in terms of visualisation and spatial resolution. Ultra-high definition (UHD) 4K systems, recently introduced in the clinical practice, will shape next steps forward especially in skull base surgery field. Patients were operated on through transnasal transsphenoidal endoscopic approaches performed using Olympus NBI 4K UHD endoscope with a 4 mm 0° Ultra Telescope, 300 W xenon lamp (CLV-S400) predisposed for narrow band imaging (NBI) technology connected through a camera head to a high-quality control unit (OTV-S400 - VISERA 4K UHD) (Olympus Corporation, Tokyo, Japan). Two screens are used, one 31" Monitor - (LMD-X310S) and one main ultra-HD 55" screen optimised for UHD image reproduction (LMD-X550S). In selected cases, we used a navigation system (Stealthstation S7, Medtronic, Minneapolis, MN, US). We evaluated 22 pituitary adenomas (86.3% macroadenomas; 13.7% microadenomas). 50% were not functional (NF), 22.8% GH, 18.2% ACTH, 9% PRL-secreting. Three of 22 were recurrences. In 91% of cases we achieved total removal, while in 9% near total resection. A mean follow-up of 187 days and average length of hospitalisation was 3.09 ± 0.61 days. Surgical duration was 128.18± 30.74 minutes. We experienced only 1 case of intraoperative low flow fistula with no further complications. None of the cases required any post- or intraoperative blood transfusion. The visualisation and high resolution of the operative field provided a very detailed view of all anatomical structures and pathologies allowing an improvement in safety and efficacy of the surgical procedure. The operative time was similar to the standard 2D HD and 3D procedures and the physical strain was also comparable to others in terms of ergonomics and weight.

PMID: 28516968 [PubMed - in process]

http://ift.tt/2rle3pu

Body-worn triaxial accelerometer coherence and reliability related to static posturography in unilateral vestibular failure.

Related Articles

Body-worn triaxial accelerometer coherence and reliability related to static posturography in unilateral vestibular failure.

Acta Otorhinolaryngol Ital. 2017 Jun;37(3):231-236

Authors: Alessandrini M, Micarelli A, Viziano A, Pavone I, Costantini G, Casali D, Paolizzo F, Saggio G

Abstract
Since changes in vestibular function may be one cause of disequilibrium, major advances in measuring postural control and sensory integration in vestibular impairments have been achieved by using posturography. However, in order to overcome problems related to this type of technology, body-worn accelerometers (ACC) have been proposed as a portable, low-cost alternative to posturography for measurements of postural sway in a friendly and ecologic environment. Due to the fact that no study to date has shown the experimental validity of ACC-based measures of body sway with respect to posturography for subjects with vestibular deficits, the aim of the present study was: i) to develop and validate a practical tool that can allow clinicians to measure postural sway derangements in an otoneurological setting by ACC, and ii) to provide reliable, sensitive and accurate automatic analysis of sway that could help in discriminating unilateral vestibular failure (UVF) patients. Thus, a group of 13 patients (seven females, 6 males; mean age 48.6 ± 6.4 years) affected for at least 6 months by UVF and 13 matched healthy subjects were instructed to maintain an upright position during a static forceplate-based posturography (FBP) acquisition while wearing a Movit® sensor (by Captiks) with 3-D accelerometers mounted on the posterior trunk near the body centre of mass. Pearson product moment correlation demonstrated a high level of correspondence of four time-domain and three frequency-domain measures extracted by ACC and FBP testing; in addition, t-test demonstrated that two ACC-based time- and frequency-domain parameters were reliable measures in discriminating UVF subjects. These aspects, overall, should further highlight the attention of clinicians and researchers to this kind of sway recording technique in the field of otoneurological disorders by considering the possibility to enrich the amount of quantitative and qualitative information useful for discrimination, diagnosis and treatment of UVF. In conclusion, we believe the present ACC-based measurement of sway offers a patient-friendly, reliable, inexpensive and efficient alternative recording technique that is useful - together with clinical balance and mobility tests - in various circumstances, as well as in outcome studies involving diagnosis, follow-up and rehabilitation of UVF patients.

PMID: 28516967 [PubMed - in process]

http://ift.tt/2q2BDDP

Expanded transcanal transpromontorial approach to the internal auditory canal and cerebellopontine angle: a cadaveric study.

Related Articles

Expanded transcanal transpromontorial approach to the internal auditory canal and cerebellopontine angle: a cadaveric study.

Acta Otorhinolaryngol Ital. 2017 Jun;37(3):224-230

Authors: Presutti L, Bonali M, Marchioni D, Pavesi G, Feletti A, Anschuetz L, Alicandri-Ciufelli M

Abstract
The aim of this paper is to describe and evaluate the feasibility of an expanded endoscopic transcanal transpromotorial approach (ExpTTA) to the internal auditory canal and the cerebellopontine angle. To this end, we performed a cadaveric dissection study in September 2015. In total, 2 heads (4 sides) were dissected focusing on anatomical landmarks and surgical feasibility. Data from dissections were reviewed and analysed for further consideration. In all 4 sides of the cadavers the procedure was feasible. In all cadavers, it was necessary to extensively drill the temporo-mandibular joint and to calibrate the external ear canal to allow adequate room to manoeuver the instruments and optics and to comfortably access the cerebellopontine angle. In addition, thorough skeletonisation of the carotid artery and the jugular bulb were necessary for the same purpose. In conclusion, ExpTTA appeared to be successful to access the internal auditory canal and cerebellopontine angle region. Potential extensive and routine application of this type of approach in lateral skull base surgery will depend on the development of technology and surgical refinements and on the diffusion of skull base endoscopic skills among otolaryngologists and neurosurgical community.

PMID: 28516966 [PubMed - in process]

http://ift.tt/2pScAqL

Benefits of active middle ear implants over hearing aids in patients with sloping high tone hearing loss: comparison with hearing aids.

Related Articles

Benefits of active middle ear implants over hearing aids in patients with sloping high tone hearing loss: comparison with hearing aids.

Acta Otorhinolaryngol Ital. 2017 Jun;37(3):218-223

Authors: Lee JM, Jeon JH, Moon IS, Choi JY

Abstract
In this retrospective chart review we compared the subjective and objective benefits of active middle ear implants (AMEIs) with conventional hearing aids (HAs) in patients with sloping high tone hearing loss. Thirty-four patients with sensorineural hearing loss were treated with AMEIs. Of these, six had sloping high tone hearing loss and had worn an HA for more than 6 months. Objective assessments, a pure-tone audiogram, as well as a word recognition test, and the Korean version of the Hearing in Noise Test (K-HINT), and a subjective assessment, the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire, were performed. Tests were conducted under three circumstances: 1) the unaided state before surgery; 2) the HA-aided state before surgery; and 3) the AMEI-aided state 3 months after surgery. The average high-frequency hearing gain (≥ 2 kHz) was significantly better with AMEIs than with HAs. Although the result had no statistical significance, AMEIs showed a superior word recognition score (WRS) compared to HAs. However, the most comfortable hearing level at which the WRS was tested was significantly decreased with an AMEI compared to an HA. In the K-HINT, patients with an AMEI showed greater recognition than those fitted with an HA under both quiet and noisy conditions. The APAHB scores revealed that patients were more satisfied with an AMEI rather than an HA on all subscales. The use of vibroplasty in patients with sloping high tone loss resulted in positive hearing outcomes when compared to conventional HAs. Based on the data from this study, AMEIs provided better objective and subjective results and could, therefore, be a better alternative for the treatment of sloping hearing loss.

PMID: 28516965 [PubMed - in process]

http://ift.tt/2rnmQaC

Barbed reposition pharyngoplasty in multilevel robotic surgery for obstructive sleep apnoea.

Related Articles

Barbed reposition pharyngoplasty in multilevel robotic surgery for obstructive sleep apnoea.

Acta Otorhinolaryngol Ital. 2017 Jun;37(3):214-217

Authors: Vicini C, Meccariello G, Cammaroto G, Rashwan M, Montevecchi F

Abstract
The surgical treatment of obstructive sleep apnoea in patients who are non-compliant with continuous positive airway pressure therapy still represents a valid alternative. In recent years, the multilevel approach is becoming more diffuse in routine surgical practice, especially since the introduction of transoral robotic surgery. Barbed reposition pharyngoplasty in multilevel robotic surgery for OSA may represent a valid option to surgically approach the soft palate. Herein, we describe the technique and preliminary results of our experience.

PMID: 28516964 [PubMed - in process]

http://ift.tt/2rnVIbn

The endoscopic evaluation of the oral phase of swallowing (Oral-FEES, O-FEES): a pilot study of the clinical use of a new procedure.

Related Articles

The endoscopic evaluation of the oral phase of swallowing (Oral-FEES, O-FEES): a pilot study of the clinical use of a new procedure.

Acta Otorhinolaryngol Ital. 2017 Jun;37(3):201-206

Authors: Farneti D, Fattori B, Bastiani L

Abstract
Oral FEES (O-FEES) is an endoscopic procedure conceived to directly visualise the oral phase of swallowing. In the perspective of clinical use, the feasibility, safety and acceptability of O-FEES has been evaluated. Subsequently, the procedure was compared with the radiological gold standard. The acceptability of O-FEES was compared to that of FEES using a 10 point questionnaire submitted to a sample of 52 outpatients complaining of swallowing disorders. Repeated measure analysis of variance (rm-ANOVA) models were used to test the mean difference of acceptability in the same subjects after FEES and O-FEES. Subsequently, another sample of 8 male outpatients underwent a simultaneous O-FEES and videofluoroscopic study (VFSS). The inter-rater reliability using 10 radiological landmarks, compared to O-FEES, was blindly determined between two raters. Inter-rater agreement between the two judges for O-FEES and VFSS scores was assessed with the single score intra-class correlation coefficient (ICC). Differences between FEES and O-FEES answers for each question and among all the items considered overall were statistically significant (rm-ANOVA; F-statistic p < 0.001). The inter-rater agreement concerning endoscopic and radiological evaluations between the two raters showed strong values of intra-class correlation coefficient (ICC) (95% confidence interval): 0.875 (0.373-0.979) and 0.921 (0.542-0.986), respectively. The Bland-Altman test showed a bias of -0.24 (95% limits of agreement; -1.77 to +1.19), which suggests that both methods produced almost identical results. In clinical practice and compared with FEES, O-FEES is a well tolerated and safe procedure. Compared with the radiological gold standard, O-FEES offers reliable information about oral preparation and oral propulsion of the bolus.

PMID: 28516963 [PubMed - in process]

http://ift.tt/2pSEfrG

Design of a customised bridging mandibular prosthesis for complex reconstruction: a pilot study.

Related Articles

Design of a customised bridging mandibular prosthesis for complex reconstruction: a pilot study.

Acta Otorhinolaryngol Ital. 2017 Jun;37(3):195-200

Authors: Tarsitano A, Battaglia S, Sandi A, Marchetti C

Abstract
The gold standard for mandibular reconstruction is universally recognised and consists of the replacement of the bony part of the mandible with a bony microvascular free flap supported by a reconstructive plate. Although this procedure is feasible and reproducible in most patients, at times poor oncological prognosis or poor performance status force surgeons to consider other reconstructive solutions. In these cases, the main alternative in reconstructing a mandibular defect is represented by bridging plates combined with soft tissue flaps. However, repairing a mandibular defect with a reconstructive plate only can lead to a series of diverse complications. The most frequent complications reported are rupture and oral exposure of the plate. In this paper, we describe a new method for mandibular reconstruction using a customised bridging mandibular prosthesis (CBMP) without bone free flap.

PMID: 28516962 [PubMed - in process]

http://ift.tt/2ryEO74

Preserved Analgesia With Reduction in Opioids Through the Use of an Acute Pain Protocol in Enhanced Recovery After Surgery for Open Hepatectomy.

Background: Enhanced recovery after surgery (ERAS) pathways are designed to restore baseline physiology, mitigate surgical stressors, and hasten recovery. Paramount to this approach is optimal pain control through multimodal analgesia and limiting reliance on opioid-based medications. Recent studies have fostered growing controversy surrounding the use of epidural analgesia in the ERAS setting, especially for higher-risk procedures. We examine the analgesic end points associated with the use of epidural within the ERAS framework for open hepatectomy. Methods: From November 2013 through March 2016, postoperative analgesic end points including daily morphine equivalent administration and self-reported pain scores were prospectively collected and analyzed for 180 consecutive patients scheduled for open hepatectomy. Patients whose surgeries performed prior to July 2014 were managed using traditional strategy (pre-ERAS, n = 60), and those after July 1 underwent a comprehensive perioperative ERAS pathway (ERAS, n = 120). Results: Patients managed using the ERAS pathway had a significant reduction in morphine equivalent requirements at 24 hours (median, 10.0 vs 116.0 mg; P

http://ift.tt/2qAXKUp

Cytology-Ultrasonography Risk-Stratification Scoring System Based on Fine-Needle Aspiration Cytology and the Korean-Thyroid Imaging Reporting and Data System

Thyroid , Vol. 0, No. 0.


http://ift.tt/2qDsAML

Updated American Joint Committee on Cancer/Tumor-Node-Metastasis Staging System for Differentiated and Anaplastic Thyroid Cancer (Eighth Edition): What Changed and Why?

Thyroid , Vol. 0, No. 0.


http://ift.tt/2rBRl93

Comparison of oral fluid collection methods for the molecular detection of hepatitis B virus

Abstract

Background

This study aims to compare the efficiency of four oral fluid collection methods (Salivette, FTA Card, spitting and DNA-Sal) to detect HBV DNA by qualitative PCR.

Materials and Methods

Seventy-four individuals (32 HBV reactive and 42 with no HBV markers) donated serum and oral fluid. In-house qualitative PCR to detect HBV was used for both samples and commercial quantitative PCR for serum.

Results

HBV DNA was detected in all serum samples from HBV-infected individuals, and it was not detected in control group. HBV DNA from HBV group was detected in 17 samples collected with Salivette device, 16 samples collected by FTA Card device, 16 samples collected from spitting and 13 samples collected by DNA-Sal device. Samples that corresponded to a higher viral load in their paired serum sample could be detected using all oral fluid collection methods, but Salivette collection device yielded the largest numbers of positive samples and had a wide range of viral load that was detected.

Conclusion

It was possible to detect HBV DNA using all devices tested, but higher number of positive samples was observed when samples were collected using Salivette device, which shows high concordance to viral load observed in the paired serum samples.

This article is protected by copyright. All rights reserved.

http://ift.tt/2q5Lgkp

A comparison of attitudes to laryngeal cancer treatment outcomes: a time trade-off study

Abstract

Design

Time trade-off choice experiment.

Setting

Two large head and neck cancer centres.

Participants

Patients who have received treatment for head and neck cancer and members of the head and neck cancer multidisciplinary team.

Main outcome measures

Participants were asked to rank the outcome scenarios, assign utility values using time trade-off and rate the importance of survival on treatment choice.

Results

49 head and neck cancer patients and 73 staff members were recruited. Chemoradiotherapy (CRT) optimal outcome was the most preferred health state (34/49, 69% patients and 50/73, 68% staff) and CRT with complications was least preferred (27/49 55% patients and 51/73 70% staff). Using time trade-off, mean utility values were calculated for CRT optimal outcome (0.73 for patients, 0.77 for staff), total laryngectomy (TL) optimal outcome (0.67 for patients, 0.69 for staff), TL outcome with complications (0.46 for patients, 0.51 for staff) and CRT with complications (0.36 for patients, 0.49 for staff). The average survival advantage required for a participant to change their preferred choice was 2.6 years.

Conclusions

We have demonstrated that a significant proportion of head and neck cancer patients and staff members would not choose CRT to manage locally advanced laryngeal cancer. Staff members rated the health states associated with laryngeal cancer treatment higher than patients who have experienced them, and this is particularly evident when considering the poorer outcomes. The head and neck cancer community should develop methods of practice and decision making which incorporate elicitation and reporting of patient values as a central principle.

This article is protected by copyright. All rights reserved.

http://ift.tt/2pV7mL8

Cochlear implantation in patients with otosclerosis of the otic capsule

To evaluate outcomes of cochlear implantation of patients with otosclerosis of the otic capsule.

http://ift.tt/2qAqcWI

Indikatoren für Sprachverständnis bei Kindern mit Migrationshintergrund. Ein Extremgruppenvergleich

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-104771

Hintergrund Kinder mit Migrationshintergrund und Deutsch als Zweitsprache (DaZ) gelten häufig als sprachauffällig, was jedoch mangels fehlender Untersuchungsinstrumente im jungen Alter schwer zu objektivieren ist. Hierfür sollten empirisch Risikofaktoren bestimmt werden. Material und Methoden Aus dem Datenpool einer Entwicklungslängsschnittstudie in 7 Kitas in Frankfurt/M. u. Darmstadt wurden Migrantenkinder im Alter von 3–5;11 Jahren durch ihre Testleistung im oralen Sprachverständnis 2 Extremgruppen zugewiesen: „unauffällig" bei T-Wert ≥46 (N=61) vs. „auffällig" bei T-Wert ≤32 (N=65). Gruppenunterschiede wurden anhand von Testergebnissen (Intelligenz; Verständnis grammatischer Strukturen; sprachliche Begriffsbildung; Erkennen von semantischen und grammatischen Inkonsistenzen) analysiert. Ergebnisse Die Intelligenz war in beiden Gruppen durchschnittlich, in der unauffälligen Gruppe über dem Altersmittel gelegen: T-W 54,1; SD 6,7, in der auffälligen darunter: T-W 42,2; SD 8,8 (p<0,001). In allen Sprachleistungen unterschieden sich die Gruppen durchgängig signifikant. Diskriminanzanalytisch wurden 4 Merkmale für die Güte von DaZ identifiziert: Intelligenzhöhe; Erkennen von Sprachinkonsistenzen; Bildungsstand der Mutter; Grammatikbasiertes Sprachverständnis. Bzgl. der vorhergesagten Gruppenzugehörigkeit wurden 88% der Kinder mit auffälligem und 84% der mit unauffälligem Sprachverständnis korrekt zugeordnet. Schlussfolgerung Die Studie liefert einen akzeptablen Standard, um Migrantenkinder mit gutem Verständnis von DaZ von solchen mit schwachem zu trennen.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

http://ift.tt/2q5uMs8

Lip reconstruction using a functioning serratus anterior free flap: preliminary study

Publication date: Available online 19 May 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): A.O. Gundeslioglu, E.C. Karadag, I. Inan, L. Jasharllari, M.N. Selimoglu, F. Guney, B. Yuruten, M. Bekerecioglu
Reconstructive surgery to the lips requires the replacement of defective tissues with similarly functioning tissues. While non-dynamic free tissue transfers provide adequate lower lip reconstruction, improved benefits may be obtained with innervated free muscle flaps. This study reports the use of innervated serratus anterior muscle free flaps for lip reconstruction in five patients. All patients had squamous cell carcinoma of either the upper or lower lip. After resection of the tumours, the resultant defects comprised two-thirds of the lips. The innervated serratus anterior muscle free flap was transferred to the lip and an end-to-end vascular anastomosis on the facial artery was performed. The marginal mandibular branch of the facial nerve was preferred for nerve coaptation. The inner and outer surfaces of the flaps were grafted with a split-thickness skin graft. Concentric needle electromyography of the orbicularis oris and frontal muscles was performed for all patients in the preoperative, postoperative, and follow-up periods. All patients survived the surgical operation. Three patients achieved perfect oral sphincter function without drooling. Electromyography at 1 year postoperative demonstrated the successful reinnervation of the serratus anterior muscle. This study demonstrates that lip reconstruction using an innervated serratus anterior muscle free flap is a reliable method, providing a functional lower lip.



http://ift.tt/2rBna1V

Cochlear implantation in patients with otosclerosis of the otic capsule

Publication date: Available online 19 May 2017
Source:American Journal of Otolaryngology
Author(s): Jay Burmeister, Susan Rathgeb, Jacques Herzog
ObjectiveTo evaluate outcomes of cochlear implantation of patients with otosclerosis of the otic capsule.Study designA retrospective case series of 6 patients (7 ears).Patients6 patients (7 ears), 5 patients with severe to profound sensorineural hearing loss; 1 patient with mild to profound sensorineural hearing loss, with radiologic evidence of otosclerosis. All patients were adult males, with or without history of stapes surgery.InterventionCochlear implantation of 7 ears. 5 patients with severe to profound sensorineural hearing loss received the Nucleus Contour Advance peri-modiolar electrode array with binaural implantation performed in one patient. One patient with mild to profound sensorineural hearing loss received a Cochlear® Nucleus Hybrid L24 device.MethodsPreoperative temporal bone CT, audiometric and speech perception testing scores were reviewed, confirming presence of otosclerosis of the cochlea as well as cochlear implant candidacy. Speech perception testing included CNC words, HINT sentences and AZ Bio scores to measure hearing outcomes post implantation.ResultsAll recipients of the contour advance device had a significant improvement in hearing at both 3 and 6month follow up.The hybrid device recipient experienced loss of residual hearing in the implanted ear without improvement at 3months and mild improvement at 6months.ConclusionCochlear implantation has proven to be effective in the treatment of patients with sensorineural hearing loss, including those with otosclerosis of the cochlea.Hybrid candidacy in the setting of otosclerosis of the cochlea may require consideration of alternative electrode devices, most likely a peri-modiolar device.



http://ift.tt/2qGuOJh

Lip reconstruction using a functioning serratus anterior free flap: preliminary study

Reconstructive surgery to the lips requires the replacement of defective tissues with similarly functioning tissues. While non-dynamic free tissue transfers provide adequate lower lip reconstruction, improved benefits may be obtained with innervated free muscle flaps. This study reports the use of innervated serratus anterior muscle free flaps for lip reconstruction in five patients. All patients had squamous cell carcinoma of either the upper or lower lip. After resection of the tumours, the resultant defects comprised two-thirds of the lips.

http://ift.tt/2rAyEn7

Prevalence of hearing-loss among HAART-treated children in the Horn of Africa

Publication date: July 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 98
Author(s): Alden F. Smith, David C. Ianacone, Robbert J.H. Ensink, Abebe Melaku, Margaretha L. Casselbrant, Glenn Isaacson
ObjectivesThe prevalence of hearing loss (HL) in children infected with HIV/AIDS is not well studied. Even fewer studies focus on stable HIV-infected children treated with high-effective antiretroviral therapy (HAART). We aim to compare the prevalence of ear disease and HL in HAART-treated, HIV + children in Addis Ababa, Ethiopia with a well, similarly-aged elementary school population with unknown HIV status (HIVU).MethodsChildren underwent standard head and neck examination and cerumen removal by board certified otolaryngologists. Next, certified audiologists performed hearing screening with pure-tone audiometry using a circumaural headset but without an ambient noise reducing environment. Children failing audiometric screening underwent full behavioral audiometry including air and bone testing. The primary outcome parameter was HL > 25 dB with the audiologist accounting for background noise. A second endpoint was PTA >40 dB (500, 1000, 2000 Hz) without assessment of background noise.Results107 HIV+ and 147 HIVU children met inclusion criteria. In the HIV + cohort 17.8% had evidence of TM perforations and 8.4% had otorrhea. In the HIVU group 2.7% had a TM perforation and 0% had otorrhea. Hearing was significantly worse in HIV + children. (Audiologist determination: 38.3% HL HIV+, 12.2% HIVU, Fisher's-Exact-Test OR: 4.5, 95% CI 2.4–8.3, p-value <0.0001; Worse-hearing-ear PTA > 40 dB: 19.6% HL HIV+, 6.1% HIVU, OR: 3.7, 95% CI 1.7–8.4, p-value <0.001).ConclusionsChronic OM, conductive and mixed hearing losses are significantly more common in HAART-treated HIV + children than in well, similarly-aged controls. Rates of SNHL are similar.



http://ift.tt/2pUcv6e

Finite element method simulating temperature distribution in skin induced by 980-nm pulsed laser based on pain stimulation

Abstract

For predicting the temperature distribution within skin tissue in 980-nm laser-evoked potentials (LEPs) experiments, a five-layer finite element model (FEM-5) was constructed based on Pennes bio-heat conduction equation and the Lambert-Beer law. The prediction results of the FEM-5 model were verified by ex vivo pig skin and in vivo rat experiments. Thirty ex vivo pig skin samples were used to verify the temperature distribution predicted by the model. The output energy of the laser was 1.8, 3, and 4.4 J. The laser spot radius was 1 mm. The experiment time was 30 s. The laser stimulated the surface of the ex vivo pig skin beginning at 10 s and lasted for 40 ms. A thermocouple thermometer was used to measure the temperature of the surface and internal layers of the ex vivo pig skin, and the sampling frequency was set to 60 Hz. For the in vivo experiments, nine adult male Wistar rats weighing 180 ± 10 g were used to verify the prediction results of the model by tail-flick latency. The output energy of the laser was 1.4 and 2.08 J. The pulsed width was 40 ms. The laser spot radius was 1 mm. The Pearson product-moment correlation and Kruskal-Wallis test were used to analyze the correlation and the difference of data. The results of all experiments showed that the measured and predicted data had no significant difference (P > 0.05) and good correlation (r > 0.9). The safe laser output energy range (1.8–3 J) was also predicted. Using the FEM-5 model prediction, the effective pain depth could be accurately controlled, and the nociceptors could be selectively activated. The FEM-5 model can be extended to guide experimental research and clinical applications for humans.

http://ift.tt/2qzGIWC

Free 25(OH)D concentrations are associated with atopy and lung function in children with asthma

Evidence suggests free mono-hydroxyvitamin D (25[OH]D) concentrations are more strongly linked to certain outcomes than total concentrations; however, no studies have examined the relation between free 25(OH)D and respiratory or allergic disease.

http://ift.tt/2rmGKCC

Hochauflösungsmanometrie der pharyngealen Schluckdynamik

Zusammenfassung

Hintergrund

Zum Transport eines Speisebolus aus der Mundhöhle in den Magen ist eine regelrechte Kontraktion der Pharynxmuskulatur und eine koordinierte Funktion des oberen Ösophagussphinkters (oÖS) notwendig. Der durch die Muskelkontraktion erzeugte intraluminale Druck treibt den Bolus kontinuierlich voran. Im Gegensatz zu bildgebenden ermöglichen manometrische Verfahren eine Abschätzung des Druckaufbaus und damit der Muskelfunktion. Sie wurden zunächst für den Ösophagus und seit 7–8 Jahren auch vermehrt im Pharynx angewendet. Die pharyngeale Hochauflösungsmanometrie (pHRM) ermöglicht Druckmessungen in hoher räumlicher und zeitlicher Auflösung und so eine Beurteilung der pharyngealen Schluckmotorik.

Ziel der Arbeit

Es wird eine aktuelle Übersicht über die Durchführung, Auswertung und Interpretation der pHRM und den derzeitigen Forschungsstand gegeben.

Material und Methoden

Eine Recherche in PubMed und Scopus wurde nach den Stichworten „high-resolution manometry" und „pharynx" oder „upper esophageal sphincter" durchgeführt. Arbeiten, die originäre Daten für pHRM beinhalten, sowie Übersichtsarbeiten und Buchbeiträge wurden berücksichtigt.

Ergebnisse

Mit der pHRM können die während des Schluckens auftretenden Druckverhältnisse im Pharynx und oÖS beurteilt werden. Einen Überblick über Veränderungen der pharyngealen Schluckmotorik bietet der Druckkonturplot. Die Bestimmung von Schluckparametern ermöglicht eine differenzierte Bewertung einzelner Komponenten des Schluckvorgangs. Ein Vergleich mit Normwerten erlaubt die Abgrenzung von Störungen im Schluckablauf.

Schlussfolgerung

Auch wenn einzelne Schluckparameter für die klinische Routine noch weiter evaluiert werden müssen, sollte bereits jetzt zur vollständigen Beurteilung des Schluckvorgangs immer eine pHRM durchgeführt werden.

http://ift.tt/2qGnrBr

CHMP Recommends Brodalumab (Kyntheum) for Plaque Psoriasis

The EMA's CHMP has recommended granting marketing authorization for brodalumab (Kyntheum, LEO Pharma, A/S) for the treatment of adults with moderate to severe plaque psoriasis.
International Approvals

http://ift.tt/2qzMasE

Benchmarking of Viral Bronchiolitis Management by General Practitioners in the United Kingdom

Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.


http://ift.tt/2pU9XF5

Ternary graph as a questionnaire: a new approach to assessment of quality of life?

Publication date: Available online 18 May 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): R. Brown, L. Tomasello, D.A. Mitchell, A. Sebald, S. Stepney
This study was prompted by awareness of the importance of research into quality of life (QoL) for patients with diseases of the head and neck, the important part questionnaires currently play in this field, and awareness of the "questionnaire fatigue" experienced by many patients. Our multidisciplinary research group raised coincidental awareness of the widespread use of ternary graphs in the sciences, social sciences, and humanities as a graphical tool for quantitative, semiquantitative, or purely graphical characteristics of ternary mixtures. We explored how the basic properties of ternary graphs could be translated into an interactive electronic tool as an alternative to conventional questionnaires. We have described how this was done, and offered open access to an interactive ternary-graph based (self) assessment tool, specifically designed for the needs of patients with conditions of the head and neck. Finally, have we made open-source code available for those who may wish to adapt or develop the tool for further applications.



http://ift.tt/2rAHsJ0

Periosteal elevation induces supracortical peri-implant bone formation

Publication date: Available online 19 May 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Rainer Lutz, Christina Sendlbeck, Hommeira Wahabzada, Christian Tudor, Christopher Prechtl, Karl Andreas Schlegel
PurposeThe aim of the study was to evaluate the possibility of supracortical peri-implant bone formation after periosteal elevation.Materials and MethodsPeriosteal elevation with an elevation height of 5 or 10 mm was performed in an animal experiment with 24 female domestic pigs. For this purpose, four implants were inserted in the frontal bone of each animal. The implants protruded from the local bone by 5 or 10 mm. In the test groups, the periosteum was attached to the protruding implants. In the control groups, the implants were covered with biocompatible degradable periosteal-shielding devices. Each 8 animals were sacrificed after 20, 40 and 60 days. De novo bone formation was evaluated radiographically and histologically.ResultsBone formation rate was higher in the test groups compared to the control groups after 20, 40 and 60 days. After 40 and 60 days, a statistically significant higher (P<0.01) bone formation rate was found for both elevation heights. The maximum height of the generated bone was statistically significantly higher (P<0.01) in the test groups for both elevation heights, compared to the control groups for all time points investigated.ConclusionPeriosteal elevation by dental implants is a treatment option for supracortical peri-implant bone formation.



http://ift.tt/2r0Ui72

Compartmental tongue resection with submental island flap reconstruction for large carcinoma of the oral tongue

Abstract

Background

Tongue resection is a surgical challenge because of its adverse effects on language articulation, swallowing, respiration, the eventual quality of life, and poor prognosis of advanced disease. To date, the currently accepted standard treatment has been based on excision of the primary lesion with a 1.5–2-cm circumferential macroscopic margin. Compartmental tongue surgery (CTS) is a surgical technique that removes an anatomo-functional compartment containing the primary tumor.

Methods and techniques

This is a prospective study that was carried out from June 2012 to January 2015 for patients with carcinoma affecting oral tongue. We enrolled all cases with ≥T2 tongue cancer with or without infiltration of floor of the mouth. Patients underwent compartmental tongue resection with reconstruction using island submental flap.

Results

Pharyngeal tear occurred in two cases that were repaired by simple suture. Bleeding occurred in two cases with control of the affected vessels. Loco-regional recurrence was detected only in two cases that underwent CTS, while 18 patients who underwent traditional tongue resection had local recurrence.

Conclusion

CTS via pull through technique with submental island flap reconstruction for large tongue cancer has been evolved to improve oncologic resections, obtaining a better local control of disease and increased survival rate with concomitant successful functional and esthetic outcomes especially in elderly patients with serious comorbidities.

http://ift.tt/2q30gza

Macrophages produce IL-33 by activating MAPK signaling pathway during RSV infection

Publication date: July 2017
Source:Molecular Immunology, Volume 87
Author(s): Feifei Qi, Song Bai, Dandan Wang, Lei Xu, Haiyan Hu, Sheng Zeng, Ruonan Chai, Beixing Liu
It has been reported that RSV infection can enhance IL-33 production in lung macrophages. However, little is known about specific signaling pathways for activation of macrophages during RSV infection. In the present study, by using real-time RT-PCR as well as western blot assay, it became clear that RSV infection can enhance not only the expression of mRNAs for MAPK molecules (including p38, JNK1/2, and ERK1/2), but also the levels of MAPK proteins in lung macrophages as well as RAW264.7 cells. Furthermore, infection with RSV resulted in an increased level of phosphorylated MAPK proteins in RAW264.7 cells, suggesting that MAPK signaling pathway may participate in the process of RSV-induced IL-33 secretion by macrophages. In fact, the elevated production of IL-33 in RAW264.7 was attenuated significantly by pretreatment of the cells with special MAPK inhibitor before RSV infection, further confirming the function of MAPKs pathway in RSV-induced IL-33 production in macrophages. In contrast, the expression of NF-κB mRNA as well as the production of NF-κB protein in lung macrophages and RAW264.7 cells was not enhanced markedly after RSV infection. Moreover, RSV infection failed to induce the phosphorylation of NF-κB in RAW264.7 cells, suggesting that NF-κB signaling pathway may be not involved in RSV-induced IL-33 production in macrophages. Conclusion, these results indicate that RSV-induced production of IL-33 in macrophages is dependent on the activation of MAPK signaling pathway.



http://ift.tt/2r0OZnX

Assessing degradation of composite resin cements during artificial aging by Martens hardness

Aim of the study was to verify the efficiency of Martens hardness measurements in detecting the degradation of composite resin cements during artificial aging.

http://ift.tt/2qFVqKl

Benchmarking of Viral Bronchiolitis Management by General Practitioners in the United Kingdom

Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.


http://ift.tt/2pTJd7K

Post-Laryngectomy Stricture and Pharyngocutaneous Fistula: Review of Techniques in Primary Pharyngeal Reconstruction in Laryngectomy

Abstract

Objective

The purpose of this study is to find a correlation between closure technique in pharyngeal closure and outcomes of both pharyngocutaneous fistula and post-laryngectomy stricture after laryngectomy.

Study Design

Retrospective Chart Review.

Methods

We retrospectively reviewed a total of 151 patients over a 20 year period from January 1994 to December of 2013 who underwent primary pharyngeal reconstruction after total laryngectomy specifically looking at the closure technique in relation to pharyngo-cutaneous fistula (PCF) and post-laryngectomy stricture post-operatively. Patients were excluded based on secondary pharyngeal closure. Using logistic regression modeling, we performed univariate and multivariate analysis of our data.

Results

The overall PCF and post-laryngectomy stricture rates were 19.1% and 15.8%. When salvage laryngectomy was excluded, t-type closure had a significantly lower risk of fistula rate (p = 0.038) compared to vertical closure. In multivariate analysis, this statistical significance was lost (p = 0.23); however, non-salvage t-type closure remained significantly better than both salvage laryngectomy groups (t-type, p = 0.033, vertical, p = 0.037) while non-salvage vertical closure had no significant difference from other groups. There was no difference in stricture rate between the two closure techniques (p = 0.63)

Conclusion

Our study supports the role of t-type closure decreasing fistula rates in primary pharyngeal reconstruction. Orientation of the pharyngeal closure does not appear to change the risk of post-laryngectomy stricture formation after total laryngectomy. Salvage laryngectomy with primary pharyngeal reconstruction remains an independent risk factor for fistula formation.

This article is protected by copyright. All rights reserved.

http://ift.tt/2qBPB2A

Dietary Behaviors in Psoriasis: Patient-Reported Outcomes from a U.S. National Survey

Abstract

Introduction

Psoriasis patients demonstrate high interest in the role of diet on their skin condition. However, data are lacking to describe dietary interventions among psoriasis patients and associated outcomes. This study aims to identify common dietary habits, interventions and perceptions among patients with psoriasis, and to examine patient-reported skin outcomes in response to these interventions.

Methods

We administered a 61-question survey to the National Psoriasis Foundation membership asking psoriasis patients about dietary habits, modifications, skin responses, and perceptions.

Results

A total of 1206 psoriasis patients responded to the survey. Compared to age- and sex-matched controls, psoriasis patients consumed significantly less sugar, whole grain fiber, dairy, and calcium (p < 0.001), while consuming more fruits, vegetables, and legumes (p < 0.01). Eighty-six percent of respondents reported use of a dietary modification. The percentage of patients reporting skin improvement was greatest after reducing alcohol (53.8%), gluten (53.4%), nightshades (52.1%), and after adding fish oil/omega-3 (44.6%), vegetables (42.5%), and oral vitamin D (41%). Specific diets with the most patients reporting a favorable skin response were Pagano (72.2%), vegan (70%), and Paleolithic (68.9%). Additionally, 41.8% of psoriasis respondents reported that a motivation for attempting dietary changes was to improve overall health.

Conclusion

This national survey is among the first to report the dietary behaviors of patients with psoriasis. The data provided from this large cohort may benefit patients and clinicians as they discuss the role of diet in managing both psoriasis and associated cardiometabolic comorbidities.

http://ift.tt/2qyXqW5

Efficacy and Adverse Events of Oral Isotretinoin for Acne: A Systematic Review

Abstract

Despite many years of clinical use of isotretinoin, a comprehensive review of evidence for isotretinoin therapy in acne patients is lacking. We searched MEDLINE, EMBASE, Cochrane Central, relevant webpages and bibliographies for randomized controlled trials for acne evaluating isotretinoin vs control (placebo or other therapy). Data were extracted and summarized descriptively. Eleven trials were identified (total n=760 patients randomized), containing mostly males. Mean treatment ages ranged from 18 to 47.9 years and participants generally had moderate-severe acne. Across all trials, isotretinoin therapy reduced acne lesion counts by a clinically relevant amount, and always by a greater amount than control, which were either placebo (n=2 studies), oral antibiotics (n=7 studies), or other control (n=2 studies). Across trials with an overall low risk of bias, 2/3 demonstrated statistically significant differences between isotretinoin and control. The frequency of adverse events was twice as high with isotretinoin (n=751 events) compared to control (n=388 events). More than half of all adverse events were dermatologic and related to dryness. Adverse events from isotretinoin causing participant withdrawal from trials (n=12 patients) included Stevens-Johnson Syndrome, cheilitis, xerosis, acne flare, photophobia, elevated liver enzymes, decreased appetite, headaches and depressed mood. This review suggests that isotretinoin is effective in reducing acne lesion counts, but adverse events are common. PROSPERO CRD42015025080.

This article is protected by copyright. All rights reserved.

http://ift.tt/2q0F5ik

Updating the diagnosis,classification and assessment of rosacea by effacement of subtypes: reply from author

The National Rosacea Society Expert Committee (NRSCOR) 2002 publication indicated that the definition and classification system then proposed was based on scientific knowledge, that it was provisional, and that it would be refined with increasing knowledge.¹ A move from subtyping towards a phenotype approach was proposed by the American Acne and Rosacea Society (AARS)² and ROSCO presents the first international effort to advance the diagnosis and classification of rosacea.

This article is protected by copyright. All rights reserved.

http://ift.tt/2rmkJnz

Comparison of ixekizumab with ustekinumab in moderate-to-severe psoriasis: 24-week results from IXORA-S, a Phase 3 study

Abstract

Background

The interleukin (IL)-23/IL-17 axis has been shown critical in the pathogenesis of psoriasis.

Objectives: To present the primary endpoint (Week 12) and safety/efficacy data up to Week 24 from a head-to-head trial (IXORA-S) of the IL-17A inhibitor, ixekizumab (IXE), vs. the IL-12/23 inhibitor ustekinumab (UST).

Methods

Randomised patients received IXE (160-mg starting dose, then 80 mg every two weeks for 12 weeks, then 80 mg every four weeks, N=136) or UST (45 mg/90 mg weight-based dosing per label, N=166). The primary endpoint was the proportion of patients reaching ≥90% Psoriasis Area and Severity Index improvement (PASI 90). Hommel-adjusted key secondary endpoints at Week 12 included PASI 75, PASI 100, static physician global assessment (sPGA) (0,1), sPGA (0), Dermatology Life Quality Index (DLQI) score of (0,1), ≥4-point reduction on the itch Numeric Rating Scale (NRS), and changes in itch NRS and skin pain Visual Analog Scale (VAS).

Results

At Week 12, IXE (n=99, 72.8%) was superior to UST (n=70, 42.2%) in PASI 90 response (response difference: 32.1%; 97.5% confidence interval: 19.8%−44.5%; p<.001). Response rates for PASI 75, PASI 100, and sPGA (0,1) were significantly higher for IXE vs. UST (adjusted p<.05). At Week 24, IXE-treated patients had significantly higher response rates than UST-treated patients for PASI, sPGA, and DLQI (unadjusted p<.05). No deaths were reported, and treatments did not differ with regard to overall incidences of adverse events (p=.299).

Conclusions

The superior efficacy of IXE demonstrated at Week 12 persisted up to Week 24. Safety profiles were consistent with what has been previously reported for both treatments.

This article is protected by copyright. All rights reserved.

http://ift.tt/2q0THhr

Validation of the pathological classification of lymph node metastasis for head and neck tumors according to the 8th edition of the TNM Classification of Malignant Tumors

Publication date: July 2017
Source:Oral Oncology, Volume 70
Author(s): Jacinto García, Montserrat López, Laura López, Silvia Bagué, Esther Granell, Miquel Quer, Xavier León
ObjectivesOne of the main changes in the 8th edition of the TNM Classification for head and neck tumors is the inclusion of extracapsular spread (ECS) as a criterion for evaluating the regional extension, both clinical (cN) and pathological (pN). The objective of our study is to evaluate the prognostic capacity derived from the inclusion of the ECS in the pathological classification of head and neck squamous cell carcinoma (HNSCC) patients treated with a neck dissection, as established by the 8th edition TNM Classification.Materials and methodsRetrospective study of 1188 patients with HNSCC treated with a neck dissection between1990 and 2013.ResultsThere were lymph node metastasis in 50.1% of the neck dissections. The pathological record revealed ECS in 50.5% of the positive neck dissections. The implementation of the changes of the 8th edition TNM classification produced the upstaging of 20.9% of the patients classified as pN1 with the 7th edition TNM classification to pN2a¸ and the upstaging of 58.4% of the patients classified as pN2 with the 7th edition TNM classification to pN3b. We conducted an objective comparison of the quality of both classifications. The 8th TNM classification edition achieved better results regarding both the discrimination in cause-specific survival between pN categories and in the distribution in the number of cases between categories than the 7th edition TNM classification.ConclusionThe inclusion of ECS in the pathological classification (pN) of the neck nodes improves the prognostic capacity of the 8th TNM Classification edition.



http://ift.tt/2rA2lUH

Allergen immunotherapy for allergic asthma: a systematic review and meta-analysis

Abstract

Background

To inform the development of the European Academy of Allergy and Clinical Immunonology's (EAACI) Guidelines on Allergen Immunotherapy (AIT) for allergic asthma, we assessed the evidence on the effectiveness, cost-effectiveness and safety of AIT.

Methods

We performed a systematic review, which involved searching nine databases. Studies were screened against pre-defined eligibility criteria and critically appraised using established instruments. Data were synthesized using random-effects meta-analyses.

Results

98 studies satisfied the inclusion criteria. Short-term symptom scores were reduced with a standardized mean difference (SMD) of -1.11 (95%CI -1.66, -0.56). This was robust to a pre-specified sensitivity analyses, but there was evidence suggestive of publication bias. Short-term medication scores were reduced SMD -1.21 (95%CI -1.87, -0.54), again with evidence of potential publication bias. There was no reduction in short-term combined medication and symptom scores SMD 0.17 (95%CI -0.23, 0.58), but one study showed a beneficial long-term effect.

For secondary outcomes subcutaneous immunotherapy (SCIT) improved quality of life and decreased allergen specific airways hyperreactivity (AHR) but this was not the case for sub-lingual immunotherapy (SLIT). There were no consistent effects on asthma control, exacerbations, lung function, and non-specific AHR.

AIT resulted in a modest increased risk of adverse events (AEs). Although relatively uncommon, systemic AEs were more frequent with SCIT; however no fatalities were reported.

The limited evidence on cost-effectiveness was mainly available for sublingual immunotherapy (SLIT) and this suggested that SLIT is likely to be cost-effective.

Conclusions

AIT can achieve substantial reductions in short-term symptom and medication scores in allergic asthma. It was however associated with a modest increased risk of systemic and local AEs. More data are needed in relation to secondary outcomes, longer-term effectiveness and cost-effectiveness.

This article is protected by copyright. All rights reserved.

http://ift.tt/2q1b4Pg

The Burden of Chronic Spontaneous Urticaria Is Substantial: Real-World Evidence From ASSURE-CSU

Abstract

Background

Chronic spontaneous urticaria (CSU) can be debilitating, difficult to treat, and frustrating for patients and physicians. Real-world evidence for the burden of CSU is limited. The objective of this study was to document disease duration, treatment history, and disease activity, as well as impact on health-related quality of life (HRQoL) and work among patients with inadequately controlled CSU, and to describe its humanistic, societal, and economic burden.

Methods

This international observational study assessed a cohort of 673 adult patients with CSU whose symptoms persisted for ≥12 months despite treatment. Demographics, disease characteristics, and health care resources in the previous 12 months were collected from medical records. Patient-reported data on urticaria and angioedema symptoms, HRQoL, and work productivity and activity impairment were collected from a survey and a diary.

Results

Almost 50% of patients had moderate-to-severe disease activity as reported by Urticaria Activity Score. Mean (SD) Dermatology Life Quality Index and Chronic Urticaria Quality of Life Questionnaire scores were 9.1 (6.62) and 33.6 (20.99), respectively. CSU markedly interfered with sleep and daily activities. Angioedema in the previous 12 months was reported by 66% of enrolled patients and significantly affected HRQoL. More than 20% of patients reported ≥1 hour per week of missed work; productivity impairment was 27%. These effects increased with greater disease activity. Significant health care resources and costs were incurred to treat CSU.

Conclusions

CSU has considerable humanistic and economic impacts. Patients with greater disease activity and with angioedema experience greater HRQoL impairments.

This article is protected by copyright. All rights reserved.

http://ift.tt/2rm0shD

Assessing degradation of composite resin cements during artificial aging by Martens hardness

Abstract

Background

Aim of the study was to verify the efficiency of Martens hardness measurements in detecting the degradation of composite resin cements during artificial aging.

Methods

Four cements were used: Variolink II (VL2), RelyX Unicem 2 Automix (RUN), PermaFlo DC (PDC), and DuoCem (DCM). Specimens for Martens hardness measurements were light-cured and stored in water at 37 °C for 1 day to allow complete polymerization (baseline). Subsequently the specimens were artificially aged by water storage at 37 °C or thermal cycling (n = 6). Hardness was measured at baseline as well as after 1, 4, 9 and 16 days of aging. Specimens for indirect tensile strength measurements were produced in a similar manner. Indirect tensile strength was measured at baseline and after 16 days of aging (n = 10). The results were statistically analyzed using one-way ANOVA (α = 0.05).

Results

After water storage for 16 days hardness was significantly reduced for VL2, RUN and DCM while hardness of PDC as well as indirect tensile strength of all cements were not significantly affected. Thermal cycling significantly reduced both, hardness and indirect tensile strength for all cements. No general correlation was found between Martens hardness and indirect tensile strength. However, when each material was analyzed separately, relative change of hardness and of indirect tensile strength revealed a strong linear correlation.

Conclusions

Martens hardness is a sensible test method to assess aging of resin composite cements during thermal cycling that is easy to perform.

http://ift.tt/2q0NDWf

Patterns of anaphylaxis after diagnostic work-up: a follow-up study of 226 patients with suspected anaphylaxis

Abstract

Background

Most published studies on anaphylaxis are retrospective or register based. Data on subsequent diagnostic work-up are sparse. We aimed to characterize patients seen with suspected anaphylaxis at the emergency care setting (ECS), after subsequent diagnostic work-up at our Allergy Center (AC).

Methods

Prospective study including patients from the ECS, Odense University Hospital, during May 2013–April 2014. Possible anaphylaxis cases were daily identified based on a broad search profile including history and symptoms in patient records, diagnostic codes and pharmacological treatments. At the AC, all patients were evaluated according to international guidelines.

Results

Among 226 patients with suspected anaphylaxis, the diagnosis was confirmed in 124 (54.9%) after diagnostic work-up; 118 of the 124 fulfilled WAO/EAACI criteria of anaphylaxis at the ECS, while 6 were found among 46 patient with clinical suspicion but not fulfilling the WAO/EAACI criteria at the ECS. The estimated incidence rate of anaphylaxis was 26 cases per 100,000 person years and the one year period prevalence was 0.04%. The most common elicitor was drugs (41.1%) followed by venom (27.4%) and food (20.6%). In 13 patients (10.5%) no elicitor could be identified. Mastocytosis was diagnosed in 7.7% of adult patients and was significantly associated with severe anaphylaxis. Atopic diseases were significantly associated only with food-induced anaphylaxis. Co-factors were present in 58.1% and were significantly associated with severe anaphylaxis.

Conclusion

A broad search profile in the ECS and subsequent diagnostic work-up is important for identification and classification of patients with anaphylaxis. Evaluation of co-morbidities and co-factors are important.

This article is protected by copyright. All rights reserved.

http://ift.tt/2pT9tiy

Chemoradiation +/- Surgery Versus Systemic Therapy for Esophageal or Gastric Cancer With Oligometastases

Conditions:   Malignant Neoplasms of Digestive Organs;   Esophageal Cancer;   Gastric Cancer
Interventions:   Drug: Chemotherapy;   Radiation: Radiation;   Procedure: Surgery;   Behavioral: Symptom Questionnaires
Sponsor:   M.D. Anderson Cancer Center
Not yet recruiting - verified May 2017

http://ift.tt/2rzf4GW

Functional ImaGing of Heterogeneity in Head and Neck Tumors - Validation From Surgical Specimens

Condition:   Squamous Cell Carcinoma of the Head and Neck
Intervention:   Other: All patients
Sponsor:   Rigshospitalet, Denmark
Recruiting - verified May 2017

http://ift.tt/2qAZZHW

Efficacy of a Mechanical Chair for Treatment of Benign Paroxysmal Positional Vertigo (BPPV)

Conditions:   Vertigo;   Benign Paroxysmal Positional Vertigo
Interventions:   Other: Standard Repositioning;   Other: Mechanical Chair Repositioning;   Other: Sham Treatment
Sponsor:   Vanderbilt University Medical Center
Not yet recruiting - verified May 2017

http://ift.tt/2q0iZMF

Genetic Analysis of Pheochromocytomas, Paragangliomas and Associated Conditions

Conditions:   Pheochromocytoma;   Paraganglioma;   Inherited Cancer Syndrome;   Associated Conditions;   Kidney Neoplasms;   Bone Cancer;   Thyroid Neoplasms;   Other Cancer
Intervention:   Genetic: Genetic screening
Sponsor:   The University of Texas Health Science Center at San Antonio
Recruiting - verified May 2017

http://ift.tt/2qB8Toz

HIV and Other Risk Factors for Esophageal Squamous Cell Carcinoma in Malawi

Condition:   Esophageal Squamous Cell Carcinoma
Intervention:  
Sponsor:   UNC Lineberger Comprehensive Cancer Center
Not yet recruiting - verified May 2017

http://ift.tt/2rzjiyk

Study of the CD40 Agonistic Monoclonal Antibody APX005M

Conditions:   Cancer;   NSCLC;   Melanoma;   Urothelial Carcinoma;   MSI-H;   Head and Neck Cancer
Intervention:   Drug: APX005M
Sponsor:   Apexigen, Inc.
Recruiting - verified May 2017

http://ift.tt/2qB1qGe

Multispectral Imaging to Characterize Patterns of Vascular Supply Within Lymphoepithelial Mucosa in Oropharyngeal Cancer

Conditions:   Oropharyngeal Carcinoma;   Oropharynx Cancer
Intervention:  
Sponsor:   Stanford University
Recruiting - verified May 2017

http://ift.tt/2rzeBpg

Bulk-filled posterior resin restorations based on stress-decreasing resin technology: a randomized, controlled 6-year evaluation

This randomized study evaluated a flowable resin composite bulk-fill technique in posterior restorations and compared it intraindividually with a conventional 2-mm resin composite layering technique over a 6-yr follow-up period. Thirty-eight pairs of Class II restorations and 15 pairs of Class I restorations were placed in 38 adults. In all cavities a single-step self-etch adhesive (Xeno V) was applied. In the first cavity of each pair, the flowable resin composite (SDR) was placed, in bulk increments of up to 4 mm. The occlusal part was completed with a layer of nanohybrid resin composite (Ceram X mono). In the second cavity of each pair, the hybrid resin composite was placed in 2-mm increments. The restorations were evaluated using slightly modified US Public Health Service (USPHS) criteria at baseline and then annually for a time period of 6 yr. After 6 yr, 72 Class II restorations and 26 Class I restorations could be evaluated. Six failed Class II molar restorations, three in each group, were observed, resulting in a success rate of 93.9% for all restorations and an annual failure rate (AFR) of 1.0% for both groups. The AFR for Class II and Class I restorations in both groups was 1.4% and 0%, respectively. The main reason for failure was resin composite fracture.

http://ift.tt/2ryP0wq